Circulating Progenitor Cells Are Associated With Bioprosthetic Aortic Valve Deterioration: A Preliminary Study

• Published in: Journal of the American Heart Association Vol. 12; no. 2; p. e027364
• Main Authors: Kanaji, Yoshihisa, Ozcan, Ilke, Toya, Takumi, Gulati, Rajiv, Young, Melissa, Kakuta, Tsunekazu, Lerman, Lilach O, Lerman, Amir
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 17.01.2023; Wiley
• Subjects: Aortic Valve - diagnostic imaging; Aortic Valve - surgery; aortic valve stenosis; Aortic Valve Stenosis - epidemiology; Aortic Valve Stenosis - surgery; Bioprosthesis; bioprosthetic valve deterioration; circulating progenitor cells; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Humans; Leukocytes, Mononuclear; Original Research; Osteocalcin; Prospective Studies; Prosthesis Design; Prosthesis Failure; Stem Cells; structural valve degeneration; Treatment Outcome; valve replacement; valve replacement; aortic valve stenosis; circulating progenitor cells; structural valve degeneration; bioprosthetic valve deterioration
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.122.027364

Background Mechanisms underlying bioprosthetic valve deterioration are multifactorial and incompletely elucidated. Reparative circulating progenitor cells, and conversely calcification-associated osteocalcin expressing circulating progenitor cells, have been linked to native aortic valve deterioration. However, their role in bioprosthetic valve deterioration remains elusive. This study sought to evaluate the contribution of different subpopulations of circulating progenitor cells in bioprosthetic valve deterioration. Methods and Results This single-center prospective study enrolled 121 patients who had peripheral blood mononuclear cells isolated before bioprosthetic aortic valve replacement and had an echocardiographic follow-up ≥2 years after the procedure. Using flow cytometry, fresh peripheral blood mononuclear cells were analyzed for the surface markers CD34, CD133, and osteocalcin. Bioprosthetic valve deterioration was evaluated by hemodynamic valve deterioration (HVD) using echocardiography, which was defined as an elevated mean transprosthetic gradient ≥30 mm Hg or at least moderate intraprosthetic regurgitation. Sixteen patients (13.2%) developed HVD during follow-up for a median of 5.9 years. Patients with HVD showed significantly lower levels of reparative CD34 CD133 cells and higher levels of osteocalcin-positive cells than those without HVD (CD34 CD133 cells: 125 [80, 210] versus 270 [130, 420], =0.002; osteocalcin-positive cells: 3060 [523, 5528] versus 670 [180, 1930], =0.005 respectively). Decreased level of CD34 CD133 cells was a significant predictor of HVD (hazard ratio, 0.995 [95% CI, 0.990%-0.999%]). Conclusions Circulating levels of CD34 CD133 cells and osteocalcin-positive cells were significantly associated with the subsequent occurrence of HVD in patients undergoing bioprosthetic aortic valve replacement. Circulating progenitor cells might play a vital role in the mechanism, risk stratification, and a potential therapeutic target for patients with bioprosthetic valve deterioration.